Bisphosphonates and Periodontal Health: A Systematic Review in Postmenopausal Women

Postmenopausal women are disproportionately affected by two prevalent chronic conditions: osteoporosis and periodontitis. Bisphosphonates (BPs) are synthetic compounds with a high affinity for bone, widely used for treating postmenopausal osteoporosis due to their ability to inhibit bone resorption, thereby increasing BMD and reducing fracture risk. This systematic review evaluates various bisphosphonate therapies in improving periodontal conditions in postmenopausal women. Fifteen studies involving 776 participants were included. These comprised randomized controlled trials (RCTs), one split-mouth RCT, and one single-group follow-up. BPs studied included zoledronic acid, alendronate, and risedronate, administered via IV, oral, or local delivery. Evaluated parameters included clinical (probing depth [PD], clinical attachment loss [CAL], plaque index [PI], gingival index [GI], bleeding on probing [BOP], sulcus bleeding index [SBI], etc.), radiographic (bone fill, density, height changes), and biochemical/microbiological (N-terminal telopeptide [NTx], bone-specific alkaline phosphatase, and bacterial counts). Most studies reported significant improvements in PD, CAL, and indices like PI, GI, and BOP. Xu et al. And Bhavsar et al. demonstrated major reductions in PD and CAL. High bone fill percentages and improved alveolar crest height was seen in some studies. Alendronate reduced ntx levels and improved BMD when evaluated under biochemical or microbiological findings. Bacterial counts also decreased post-treatment. Alendronate outperformed atorvastatin and placebo in several studies for periodontal outcomes. Bisphosphonate therapy, in various forms, provides significant benefits in managing periodontitis among postmenopausal women, with improvements noted in clinical, radiographic, and biochemical parameters. Further high-quality research is necessary to optimize treatment protocols and ensure long-term safety.